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Re: Milk Production Down? Or Something E

Thanks all!
@Meg - your post has been super helpful and informative.

As you will read below, I am trying for #1 but I will probably have to do a moderated #2 (ie more emphasis on nursing on all possible occasions and minimizing formula and pumped bottle feeding) starting soon as it will not be possible for me to be constantly around the baby (even before I head back to work in 3 weeks). The articles were also very useful.

I have been trying to breastfeed more over the last couple of days and believe my supply issues are already being addressed with this ( I have been using the galactagogues). However, since yesterday, my baby has been crying loudly (and incessantly) every time I put her on her back. This has made nursing a challenge as she also refuses to sit and drink, which she did do at times when she was younger. I have been able to nurse her when she is sleepy (just up from a nap) or after distracting her after several bouts of crying protests when I lay her down. (doesnt matter where, whether at an incline on my lap directly or on a pillow, on the bed for the side lying position or elsewhere). I am hoping this is a phase and will pass in a day or two. When she cries, she refuses the breast totally and just cries louder and louder till she is held upright and calms down over some time. I am curious if you have any thoughts about this? I am wondering if this could be because she has gotten used to being held most of the time she is awake around me but am also inclined to think it may be something else. She is not showing any signs of any other health issues right now so far as we can tell. I have tried fixing her clothes, checking her diaper etc but the crying seems unrelated to any of that. One thing I worry it might be is that now as she gets a better sense of people around her, she has noted that I often put her down when I am walking away from her for some reason (I always see her following me with her eyes, even if I left her playing with something) - or I may be over-reacting.

Second, some of the nursing is only 5-7 minutes on one side. A couple of times even after these short stints she burped heavily and once even brought some milk back up, which seems to suggest she has gotten a decent quantity. What are the average speeds of nursing? Is it possible she gets 2-3 ounces in less than 10 minutes?

Also, I didnt realize breast milk quantities didnt change over time, but the nutritional content does. I have been pumping and freezing milk and was wondering then how appropriate that milk would be for the baby down the road when we use it after a couple of months?

@Aprils magic - thanks for the clarification I changed the membranes and have not yet changed the pipes because I stopped pumping as I was feeding the baby constantly but will do so soon.

Re: Milk Production Down? Or Something E

However, since yesterday, my baby has been crying loudly (and incessantly) every time I put her on her back. This has made nursing a challenge as she also refuses to sit and drink, which she did do at times when she was younger. I have been able to nurse her when she is sleepy (just up from a nap) or after distracting her after several bouts of crying protests when I lay her down. (doesnt matter where, whether at an incline on my lap directly or on a pillow, on the bed for the side lying position or elsewhere). I am hoping this is a phase and will pass in a day or two. When she cries, she refuses the breast totally and just cries louder and louder till she is held upright and calms down over some time. I am curious if you have any thoughts about this?

This could be a sign of GERD, but if there are not other indications of that it is likely not that. Even if it is not true GERD but just a little reflux, it may help to hold baby more or less upright for at least 30 minutes after feeding.

Reflux or no, many babies do not enjoy lying on their backs, and many babies do not enjoy being left alone. For the first several months, certainly until they are able to sit up on thier own, infants generally prefer to be held in the arms of a trusted adult, often in a more or less upright postion. Personally I believe this is a part of babies survival instinct and thus a pretty strong desire on babies part. Many parents find they can have baby basically upright while the parent reclines on a couch or recliner, with babies head on the upper chest or shoulder, for example, and feet below, longitudinal, kwim? So up and down, not across your lap. And the parent can relax that way as baby snuggles and sleeps. Other parents put baby is an upright position in a sling so they have hands free and can walk around doing things, this movement also will often put baby to sleep often. This does not mean that one can never put a baby down to sleep, many times, parents find they can get baby into a good sleep in their arms and then put baby down.

If a baby has begun to cry, it does indeed get harder for a baby to calm down enough to latch and nurse. This usually becomes less of an issue as baby gets older and more of a pro at nursing, and also is able to equate the breast with all things good, (love, safety, comfort, food.) So at this age one would not expect crying to be quite such an issue, as eventually a good way to get a baby to stop crying is to show baby the breast and get her on there. But as I spoke of before, if a baby has been given bottles they may have a harder time making the breast = all things good connection, and that may be making things a bit harder. You have discovered a great secret for getting baby back to the breast-nursing when baby is sleepy. To build on that, I would suggest nursing at the very earliest cues you can, as once baby is crying it seems to become harder. But, if baby is already crying, as you have discovered, it is often helpful to calm baby first and then offer the breast.

Re: Milk Production Down? Or Something E

Second, some of the nursing is only 5-7 minutes on one side. A couple of times even after these short stints she burped heavily and once even brought some milk back up, which seems to suggest she has gotten a decent quantity. What are the average speeds of nursing? Is it possible she gets 2-3 ounces in less than 10 minutes?

A three month old may well be efficient enough at the breast to get what they need in a very short time. Also, as I mentioned before, if feedings are being sceduled or delayed, if can cause a little forceful letdown that may cause short nursing sessions, burping, and spitup. But burping and spit up are also entirely normal and forceful letdown on its face is not an issue, unless it is causing baby to refuse to nurse or to have gastrointestinal issues.

Short, frequent feedings are the norm, so nothing wrong with short as long as feedings are reasonably frequent.

Also, I didnt realize breast milk quantities didnt change over time, but the nutritional content does. I have been pumping and freezing milk and was wondering then how appropriate that milk would be for the baby down the road when we use it after a couple of months?

Breastmilk from any age for any age is far, far more healthy and appropriate for baby than the alternative. So don't worry about that.

Re: Milk Production Down? Or Something E

Thanks Meg!

On the crying - it was very bad even yesterday in the afternoon/ evening so will see how things go today. Will try and feed her anytime she seems in a good mood even if it is soon after the previous feed - yesterday she slept for 3 hrs in the morning till her shower (which is very unusual but we had put her on a swing for the first time) which threw off the number of feeds she got in the morning. In fact, I felt her overnight diapers were much less wet than usual so am watching closely to make sure she is not close to any dehydration challenges. We did feed her a bottle of formula in the evening as she was clearly hungry and would just not take the breast for over 1.5 hrs of cuddling, soothing and trying again and again.

I have a question for you - what are the early cues of hunger? I know that crying and fussiness are later stage signs, but I have more or less used the clock to suggest when I should offer her the breast, as it seems like she can/ not chew on her hands, want/not want a pacifier, etc when she is hungry (sometimes she will do these things even when she has just finished feeding and clearly doesnt want more food).

I am sad that we are seeing the breast confusion now so late in the day - ironically she had much more bottle feeding in the initial weeks before I could get her to the current level of breastfeeding and she always seemed so happy with the breast. This week (when she turned 12 weeks!) is the first time I am facing this issue. Oh well.

Also - thank you for the GERD reference. Our baby had severe gastrointestinal issues in the first three months and in fact we explored GERD initially but it has always been ruled out for lack of adequate symptoms. We got the poop testing done at one stage and that was negative too. That said, her reflux got noticeable around 7 weeks and we have her on Zantac as prescribed by the ped since, which seems to help an enormous amount. We do find ourselves spending a large amount of time (far more than the feed itself) on getting burps and holding her upright for the reflux after each feed, but this has stood us in good stead through the weeks. Also, her issues have gone down quite a bit over time as well and I am hopeful that at 4 months we will see an even more significant improvement.

We have also begun putting her to sleep on her stomach for short stretches while we are watching closely and that seems to help her with the GI issues as well.

Good to know about the breast milk and age clarification.

Thank you again for your encouragement, wisdom and practical suggestions. I am so relieved that I shared my worries here and got to hear from you and all the others.

Re: Milk Production Down? Or Something E

@Meg - four other pieces I would like to ask about -

a) I have had some few shooting pains in the breasts over the last few days (very mild and quite rare) and am wondering if I can have thrush, causing the baby to not want to drink when awake? We had suspected thrush when I had a recurring blister for several weeks and I was treated with fluconazole at the time last month and the baby got some nystatin. She didnt have any white patches (then or now).

b) I have tried to have her lay on me as I lay back to see if she will go to the breast and feed, but she doesnt seem to want that, and after a bit starts to cry as she usually does when she is laid on her tummy for tummy time. Do you have any other suggestions on how to get her to lay on me?

c) I just tried again in advance of an hour from the last (5 minute) feed but she started to drink and then started crying and refused to continue. I am now wondering if something is making my milk taste weird? I havent taken any medication of late. Is there any way to check this out? I have never tasted my milk beyond noting it is sweet and tried now to see if it tasted different.

d) I have been told that sometimes red raspberry leaf tea can have adverse effects on milk flow down the road, though not on taste. Could it be that it is affecting taste? This is what I have been using for the past several weeks.

Re: Milk Production Down? Or Something E

I have a question for you - what are the early cues of hunger? I know that crying and fussiness are later stage signs, but I have more or less used the clock to suggest when I should offer her the breast, as it seems like she can/ not chew on her hands, want/not want a pacifier, etc when she is hungry (sometimes she will do these things even when she has just finished feeding and clearly doesnt want more food).

Personally, I like to call cues "nursing cues" rather than hunger or feeding cues, because in the normal course of breastfeeding, a baby will usually nurse for many reasons, not just hunger, and this is desirable as it allows baby to get enough and for milk supply to remain appropriate.

I am sad that we are seeing the breast confusion now so late in the day

I would not blame it all on nipple confusion, because at this age many babies will normally become more of a handful at the breast. Somewhere around 3 or 4 months, babies tend to get more easily distracted, fussier at the breast, not content to nurse as much-they are waking up to the world and finding it's an exciting place! This is temporary, usually, but it can be a real challenge for many weeks. So, some of this would be normal even for an ebf baby. I do think it is being exacerbated by nipple confusion simply because we know that babies who are regularly given artificial nipples (bottles and/or pacifiers) tend to comfort nurse less, develop nipple/flow confusion, etc. and this can spell an earlier end to breastfeeding than otherwise. Does it happen in every case? No, just statistically this is something we know does happen a lot.

Re: Milk Production Down? Or Something E

a) I have had some few shooting pains in the breasts over the last few days (very mild and quite rare) and am wondering if I can have thrush, causing the baby to not want to drink when awake? We had suspected thrush when I had a recurring blister for several weeks and I was treated with fluconazole at the time last month and the baby got some nystatin. She didnt have any white patches (then or now).

Thrush is notoriously overdiagnosed, so I tend to think things are NOT thrush unless 'proven' otherwise. Trush is usually indicated by pretty bad breast pain, which can feel like shooting pain up in the breast and/or more localized nipple pain, along with flaky or shiny nipple/areola skin. If it is thrush, baby is often assymptomatic but would still need treatment. But I am not sure an assymptomatic baby would have the mouth pain that would cause her to not want to nurse. Anyone else have thoughts on that?

I would be interested in specifically when you are feeling the pain. During nursing, during letdown, between nursings, when your breasts are more full, less full, etc.

b) I have tried to have her lay on me as I lay back to see if she will go to the breast and feed, but she doesnt seem to want that, and after a bit starts to cry as she usually does when she is laid on her tummy for tummy time. Do you have any other suggestions on how to get her to lay on me?

How far are you laying back? Maybe you just want to sit up more. Despite it's name, "laid back" just means that mom is reclined, it can be as little as one would recline in a straight back chair, say at the end of a meal. Also, some moms find it easier to latch baby while sitting stright up or hunched over, and THEN lay back after baby begins to suckle. Also, laid back is jsut one positioing idea. I think it is a very good nad very uinderused one, but some moms and babies don't seem to like it and that is fine, do whatever works. As long as it is confortable for mom and baby is getting milk, the position is 'good."

c) I just tried again in advance of an hour from the last (5 minute) feed but she started to drink and then started crying and refused to continue. I am now wondering if something is making my milk taste weird? I havent taken any medication of late. Is there any way to check this out? I have never tasted my milk beyond noting it is sweet and tried now to see if it tasted different.

I have never heard of anything that makes breast milk taste weird out of the breast. (Some moms have a high lipase content in their milk which can make expressed milk taste & smell weird, particularly after it has been frozen. Interestingly, even in this case of lipase affected expressed milk, the expressed milk is not harmful at all and many babies drink it just fine, although some understandably refuse.) A new soap or lotion or deodorant may cause a baby to not want to nurse, because mom or the breast smells or tastes different. But breastmilk always tastes good at the source as far as I am aware. I doubt this is why baby did not want to nurse.

d) I have been told that sometimes red raspberry leaf tea can have adverse effects on milk flow down the road, though not on taste. Could it be that it is affecting taste? This is what I have been using for the past several weeks.

According to kellymom, red raspberry leaf is thought be some to be a galactagogue (increases milk supply) but she does not think it is. But nor does she caution against its use when nursing. Why are you using Red Raspberry leaf?

I wonder if you have a La Leche League meeting near you, or a hospital based mommy and me type group that is breastfeeding supportive, something. It really might help you to get out and see other breastfed babies and how they behave. If you are not comfortable nursing in public or are afraid your baby won't nurse, bring the bottle, it's just fine. If you want to ask questions, you are bound to get lots of suggestions and support, but really I just want you to observe other breastfed babies & moms and see what they do. I think many of the things that are concerning you may be simply normal issues, but because you have concerns about dehydration, milk supply, etc, you jump right to the bottle as the solution rather than relaxing about it and just offering the breast a bit later, kwim? Any baby and mommy meeting will do but you want one where at least some of the moms are holding/juggling/swaying/walking/nursing their babies. If everyone is sitting in chairs and have baby in a car seat at their feet, that won't tell you much.

Last edited by @llli*lllmeg; February 11th, 2012 at 12:39 PM.
Reason: no time to go back and fix all typos sorry!

Re: Milk Production Down? Or Something E

Thanks Meg

I will try and locate a meeting nearby if possible as you advise. Today I did try nursing in public (for the first time) but as usual these days my baby reacted with a loud wail (which made everybody around look at us and absolutely refused to take the breast. So being around some other nursing moms might prove a big help!

But then I finally had a late afternoon round where my baby lay down happily and reached for the breast and then nursed for a while on each side. I had spent all morning with 5 minute stretches where I managed to start her off with a pacifier or soothe her to begin to sleep and then quickly start her nursing before she reacted. I did this almost on the hour as she did have some of the early cues quite regularly. She seems decently fed by evening but didnt nap at all during the day (which is unusual) and also ended the day with loud crying and refusing to nurse at all, once again. That said, I am reassured by your suggestions and comments and am hopeful things are on the mend.

On the red raspberry leaf tea, one of my friends had her LC recommend it and used it successfully through her first trimester as a supplement for nursing her twins. I switched from fenugreek which I had been using after I heard that F could sometimes cause stomach issues in some babies, which mine had a surfeit of in the early days! I am no longer feeling my milk is inadequate, so will stick with the RRL tea for now.

The breast pain is fairly mild and I havent really noticed any particular times. Not while nursing or after though. Very happy to believe it is unlikely to be thrush; I am tired after the 6 week long struggle withe infection/ blister pain/ recurrence of extreme breast pain etc which I went through a few weeks back.

Will keep trying other positions as you mention. The reclining one where I can lean back once she is latched on will be interesting to try once I get her latching on more frequently.